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GASTROENTEROLOGY

Emerging Therapies for the Treatment of Helicobacter pylori Infections

Assistant Clinical Professor, College of Pharmacy and Allied Health Professions, St. John's University, Queens, NY; Clinical Pharmacist, Beth Israel Medical Center, New York, NY

Sum Lam, PharmD CGP BCPS

Assistant Clinical Professor, College of Pharmacy and Allied Health Professions, St. John's University; Clinical Specialist in Geriatric Pharmacy, Winthrop University Hospital, Mineola, NY

Charles R Ashby Jr, PhD

Professor, College of Pharmacy and Allied Health Professions, St. John's University; Pharmaceutical Sciences Department

Reprints: Dr. Jodlowski, College of Pharmacy and Allied Health Professions, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, fax 718/990-1986, jodlowst{at}stjohns.edu

OBJECTIVE: To describe emerging therapies, such as levofloxacin, moxifloxacin, rifabutin, rifaximin, tinidazole, doxycycline, minocycline, lactoferrin, and plaunotol for the eradication of Helicobacter pylori infection.

DATA SOURCES: Relevant information was identified through a search of MEDLINE (1966–July 2008), PubMed (1955–July 2008), American Search Premier (1975–July 2008), International Pharmaceutical Abstracts (1960–2008), Science Citation Index Expanded (1996–2008), Cochrane Databases (publications archived until July 2008), and various tertiary sources using the terms Helicobacter pylori, fluoroquinolones, levofloxacin, moxifloxacin, rifabutin, rifaximin, lactoferrin, plaunotol, tinidazole, doxycycline, minocycline, faropenem, new treatments, refractory, and salvage alone or in combination.

STUDY SELECTION AND DATA EXTRACTION: Relevant information was identified and selected based on clinical relevance and value of information. In vitro and in vivo data were included if available.

DATA SYNTHESIS: Data exist supporting the use of levofloxacin or rifabutin as salvage therapies for H. pylori infection. Levofloxacin triple therapy has been recommended in the current treatment guideline, but more data are needed, especially from studies conducted in the US. A rifabutin-based regimen is better tolerated than conventional quadruple therapy, but its use is limited due to cost, hematologic adverse effects, drug interactions, and predicted development of resistance. Tinidazole appears to be an option, particularly as sequential therapy when combined with other agents; however, its use is limited by the high prevalence of nitroimidazole-resistant H. pylori strains in the US. Moxifloxacin data are limited. Data supporting the use of rifaximin, doxycycline, and minocycline are lacking or do not show benefit of these drugs over standard treatments.

CONCLUSIONS: H. pylori infection remains one of the most significant infections worldwide, and treatment failure rate with the current standard therapy continues to rise. Other treatment options should be explored to meet the emerging challenge.

Key Words: doxycycline, fluoroquinolones, Helicobacter pylori, lactoferrin, levofloxacin, minocycline, moxifloxacin, plaunotol, rifabutin, rifaximin, tinidazole

Published Online, October 9, 2008. www.theannals.com, DOI 10.1345/aph.1L234

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-08-021-H01-P